| NPI | 1407043151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301509459) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MA 240715) |
| 208100000X Physical Medicine & Rehabilitation (Licence: OH 35125902) | |
| Enumeration Date | 2007-09-26 |
| Last Update Date | 2025-07-11 |