| NPI | 1366659294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA A98822) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: OH 35087954) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2023-01-23 |