| NPI | 1457325052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: OH 34-00-7211) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: OH 34007211G) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: OH 34007211) | |
| Enumeration Date | 2006-02-13 |
| Last Update Date | 2016-02-05 |