| NPI | 1699762229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080S0010X Pediatrics Sports Medicine (Licence: OH 34005529) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34005529) |
| 207QS0010X Family Medicine Sports Medicine (Licence: OH 34005529) | |
| Enumeration Date | 2005-09-29 |
| Last Update Date | 2022-02-18 |