| NPI | 1588013221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: OH 35.148818) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL MD.38274) |
| Enumeration Date | 2016-06-03 |
| Last Update Date | 2023-11-29 |