| NPI | 1033157367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: OH 35-06-7511) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WV 18701) |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2015-02-06 |