| NPI | 1316566300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: OH 34.016267) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 34.016267) |
| Enumeration Date | 2020-04-10 |
| Last Update Date | 2024-09-06 |