| NPI | 1134547615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: OH 34.013025) |
| Additional Taxonomies | 207QS0010X Family Medicine Sports Medicine (Licence: OH 34-013025) |
| Enumeration Date | 2014-04-02 |
| Last Update Date | 2021-06-08 |