| NPI | 1255398327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: OH 35.090206) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD428286) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: PA MD428286) | |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2020-12-15 |