| NPI | 1972763779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 57012652) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35.091977) |
| Enumeration Date | 2008-06-15 |
| Last Update Date | 2023-09-29 |