| NPI | 1962631283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.133066) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA MD.207329) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: LA MD.207329) | |
| Enumeration Date | 2009-07-08 |
| Last Update Date | 2022-06-09 |