| NPI | 1982683660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.026203) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35.026203) |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2018-10-11 |