| NPI | 1770557001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OH 35059976) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: OH 35059976) |
| 208D00000X General Practice (Licence: OH 35059976G) | |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2021-01-07 |