| NPI | 1255351201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RS0010X Internal Medicine Sports Medicine (Licence: OH 35084571) |
| Additional Taxonomies | 207RS0010X Internal Medicine Sports Medicine (Licence: PA PA MD429317) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2012-10-09 |