| NPI | 1154539617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: OH 35.091457) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35.091457) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 57-00-8711) | |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2021-03-31 |