NPI | 1457566101 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35088737) |
Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: OH 35-088737) |
Enumeration Date | 2007-05-14 |
Last Update Date | 2023-11-03 |