| NPI | 1114105715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: AZ 60668) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: OH 35090374) |
| Enumeration Date | 2008-02-06 |
| Last Update Date | 2023-08-24 |