NPI | 1043571037 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: OH 34.011259) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34-011259) |
Enumeration Date | 2012-06-06 |
Last Update Date | 2023-10-11 |