| NPI | 1013121755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: OH 35-122953) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301088601) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2021-01-19 |