| NPI | 1215212691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NC 183488) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57020097) |
| Enumeration Date | 2011-10-17 |
| Last Update Date | 2024-02-28 |