NPI | 1356604391 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: OH 35129075) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT-202823) |
Enumeration Date | 2012-06-22 |
Last Update Date | 2016-08-16 |