| NPI | 1578654273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: OH 35-088580) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35088580) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2015-07-29 |