| NPI | 1427519982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 66991) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 57.247348) |
| 2080S0010X Pediatrics, Sports Medicine (Licence: AZ 66991) | |
| Enumeration Date | 2019-03-27 |
| Last Update Date | 2024-07-25 |