NPI | 1205811932 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2080S0010X Pediatrics, Sports Medicine (Licence: OH 35083261) |
Additional Taxonomies | 207PS0010X Emergency Medicine, Sports Medicine (Licence: OH 35083261) |
207Q00000X Family Medicine (Licence: OH 35083261) | |
207QS0010X Family Medicine, Sports Medicine (Licence: OH 35083261) | |
207R00000X Internal Medicine (Licence: OH 35083261) | |
207RS0010X Internal Medicine, Sports Medicine (Licence: OH 35083261) | |
208000000X Pediatrics (Licence: OH 35083261) | |
2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: OH 35083261) | |
Enumeration Date | 2005-12-15 |
Last Update Date | 2023-07-07 |