| NPI | 1427462639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: MI 5101021055) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: OH 58.007950) |
| 207Q00000X Family Medicine (Licence: MI 5101021055) | |
| Enumeration Date | 2014-06-16 |
| Last Update Date | 2023-10-11 |