| NPI | 1770560534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 34002743) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: OH 34002743) |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2013-12-09 |