| NPI | 1902122880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: OH 35.131722) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 46922) |
| 207Q00000X Family Medicine (Licence: KY 46922) | |
| Enumeration Date | 2010-04-16 |
| Last Update Date | 2022-01-25 |