NPI | 1225017452 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: OH 35-086232) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 35-086232) |
Enumeration Date | 2006-01-16 |
Last Update Date | 2013-02-26 |