| NPI | 1568817633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: OH 35.139099) |
| Additional Taxonomies | 2080S0010X Pediatrics, Sports Medicine (Licence: OH 35.139099) |
| Enumeration Date | 2016-04-26 |
| Last Update Date | 2024-11-20 |