| NPI | 1992771869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME125426) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.049114) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: OH 35.049114) | |
| Enumeration Date | 2006-02-28 |
| Last Update Date | 2022-09-30 |