| NPI | 1952580979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 34-009923) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: OH 34-009923) |
| Enumeration Date | 2007-10-26 |
| Last Update Date | 2013-01-18 |