| NPI | 1356604391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CT 79707) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: OH 35129075) |
| Enumeration Date | 2012-06-22 |
| Last Update Date | 2024-12-03 |