NPI | 1487862728 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2080S0010X Pediatrics, Sports Medicine (Licence: OH 35092293) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35092293) |
207QS0010X Family Medicine, Sports Medicine (Licence: OH 35092293) | |
Enumeration Date | 2007-05-18 |
Last Update Date | 2022-02-18 |