| NPI | 1700826005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35-054973) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: OH 35-054973) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2013-11-13 |