| NPI | 1205878790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35085326) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: OH 35085326) |
| Enumeration Date | 2006-06-11 |
| Last Update Date | 2011-01-19 |