| NPI | 1104801984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 34006675) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: OH 34006675) |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2022-02-07 |