| NPI | 1376529453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35074828) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: OH 35074828) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: OH 35-074828) | |
| Enumeration Date | 2005-12-20 |
| Last Update Date | 2022-01-05 |