| NPI | 1558990689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: OH 34.016477) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34.016477) |
| Enumeration Date | 2020-04-01 |
| Last Update Date | 2024-10-28 |