| NPI | 1184067761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: OH 35130641) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.144284) |
| 208100000X Physical Medicine & Rehabilitation (Licence: OH 35.130641) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-04-12 |
| Last Update Date | 2022-08-30 |