| NPI | 1740286673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine (Licence: OH 34-0043305) |
| Additional Taxonomies | 207RS0010X Internal Medicine, Sports Medicine (Licence: WV 1113) |
| 207RS0010X Internal Medicine, Sports Medicine (Licence: PA 05007044E) | |
| Enumeration Date | 2005-06-24 |
| Last Update Date | 2025-05-15 |