| NPI | 1427053610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35083557) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: OH 35083557) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: OH 35-083557) | |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2022-01-03 |