| NPI | 1255514394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: OH 35129623) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: AL MD32681) |
| Enumeration Date | 2007-12-12 |
| Last Update Date | 2020-12-01 |