| NPI | 1215915897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: OH 35.062504) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: OH 35.062504) |
| Enumeration Date | 2006-01-04 |
| Last Update Date | 2019-10-28 |