| NPI | 1861654766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35098054) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 11014580) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: OH 35.098054) | |
| Enumeration Date | 2008-07-01 |
| Last Update Date | 2018-03-17 |