| NPI | 1932787538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: OH 35.153355) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A193397) |
| Enumeration Date | 2021-04-02 |
| Last Update Date | 2025-07-01 |