| NPI | 1366649261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine (Licence: OH 35-094174) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57010920) |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2021-01-13 |