| NPI | 1982809273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: OH 35089810) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: CO DR.0068644) |
| Enumeration Date | 2007-06-18 |
| Last Update Date | 2022-06-03 |