| NPI | 1790775641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: OH 35-06-8376) |
| Additional Taxonomies | 204R00000X Electrodiagnostic Medicine (Licence: OH 35-06-8376) |
| Enumeration Date | 2005-10-24 |
| Last Update Date | 2023-08-17 |