| NPI | 1205221991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: OH 34014613) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: IA R-11673) |
| Enumeration Date | 2015-03-31 |
| Last Update Date | 2020-08-07 |