| NPI | 1972123222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: OH 34.017469) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: WV 4299) |
| Enumeration Date | 2020-04-16 |
| Last Update Date | 2024-09-30 |