| NPI | 1053622407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0101271257) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: OH 123954) |
| Enumeration Date | 2010-06-30 |
| Last Update Date | 2021-02-15 |