| NPI | 1063491736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: OH 35048335P) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 046335) |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2013-10-11 |