| NPI | 1326314352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: MD D0082134) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.127356) |
| Enumeration Date | 2012-03-23 |
| Last Update Date | 2023-11-07 |