| NPI | 1629380878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: OH 35.121300) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH AR 2812750 RS54) |
| Enumeration Date | 2010-07-04 |
| Last Update Date | 2024-03-06 |