| NPI | 1982651659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 1293) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 34-004918) |
| 207P00000X Emergency Medicine (Licence: WV 1293) | |
| 2083X0100X Preventive Medicine, Occupational Medicine (Licence: WV 1293) | |
| 2083X0100X Preventive Medicine, Occupational Medicine (Licence: OH 34-004918) | |
| Enumeration Date | 2006-05-28 |
| Last Update Date | 2012-08-31 |