| NPI | 1396799946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: OH 35081408) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: KY 41266) |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2022-07-21 |