| NPI | 1972535094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: OH 34.007672) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: OH 34007672) |
| 208D00000X General Practice (Licence: OH 34007672J) | |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2022-07-26 |