| NPI | 1922007590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.077821) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: OH 35 077821) |
| Enumeration Date | 2005-07-18 |
| Last Update Date | 2017-12-12 |