| NPI | 1568779924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 34.010486) |
| Additional Taxonomies | 207QS0010X Family Medicine Sports Medicine (Licence: OH 34.010486) |
| Enumeration Date | 2010-09-08 |
| Last Update Date | 2025-10-09 |