| NPI | 1134209810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME0059965) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: OH 67120) |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2010-01-19 |