| NPI | 1679916977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: OH 35128375) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH none assigned) |
| Enumeration Date | 2013-04-17 |
| Last Update Date | 2024-04-05 |