| NPI | 1396008538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080S0010X Pediatrics, Sports Medicine (Licence: OH 35-128945) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: OH 35.128945) |
| Enumeration Date | 2012-06-22 |
| Last Update Date | 2022-02-18 |