| NPI | 1063412211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: OH 35-06-0562) |
| Additional Taxonomies | 204R00000X Electrodiagnostic Medicine (Licence: OH 35060562) |
| Enumeration Date | 2005-07-29 |
| Last Update Date | 2016-01-13 |