| NPI | 1205811932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35083261) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35083261) |
| 2080S0010X Pediatrics, Sports Medicine (Licence: OH 35083261) | |
| 207Q00000X Family Medicine (Licence: OH 35083261) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: OH 35083261) | |
| 207RS0010X Internal Medicine, Sports Medicine (Licence: OH 35083261) | |
| Enumeration Date | 2005-12-15 |
| Last Update Date | 2024-10-23 |