| NPI | 1336363480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P0010X Physical Medicine & Rehabilitation, Pediatric Rehabilitation Medicine (Licence: OH 35088908) |
| Additional Taxonomies | 204R00000X Electrodiagnostic Medicine (Licence: OH 35-088908) |
| 208100000X Physical Medicine & Rehabilitation (Licence: OH 35.088908) | |
| 2081P0301X Physical Medicine & Rehabilitation, Brain Injury Medicine (Licence: OH 35-088908) | |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2022-02-21 |