| NPI | 1588668255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35082558) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: OH BT8645193) |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2022-06-15 |