| NPI | 1588896708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NY 255812) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: OH 093034) |
| Enumeration Date | 2009-08-21 |
| Last Update Date | 2022-11-16 |