| NPI | 1003806209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: OH 35045275) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: OH 35045275) |
| Enumeration Date | 2005-10-27 |
| Last Update Date | 2022-01-20 |