| NPI | 1417955428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35076907) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: OH 35076907L) |
| Enumeration Date | 2005-07-13 |
| Last Update Date | 2017-03-06 |