| NPI | 1821056680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: SC 34688) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: OH 87605) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: MI 4301074767) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: WV 20909) | |
| Enumeration Date | 2006-05-02 |
| Last Update Date | 2018-04-03 |