| NPI | 1275847063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: OH 35120979) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: MI 4301096892) |
| Enumeration Date | 2010-08-04 |
| Last Update Date | 2015-10-05 |