| NPI | 1275599763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35.087496) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35087496) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: MI 4301090929) | |
| Enumeration Date | 2006-04-24 |
| Last Update Date | 2025-11-13 |