| NPI | 1518973577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35-084799) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: OH 35-084799) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2023-08-28 |