| NPI | 1831572403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2022-00140) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: OH 35.133583) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: NC 2022-00140) | |
| Enumeration Date | 2015-07-01 |
| Last Update Date | 2025-01-02 |