| NPI | 1295296093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: OH 34.017782) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 34.017782) |
| Enumeration Date | 2019-03-26 |
| Last Update Date | 2025-09-30 |