| NPI | 1336344746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: OH 35-009402) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 58.001840) |
| Enumeration Date | 2007-06-15 |
| Last Update Date | 2025-10-28 |