| NPI | 1992791636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 4166) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: OH 4166) |
| Enumeration Date | 2005-09-27 |
| Last Update Date | 2008-02-01 |