| NPI | 1407077472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: OH 35.087168) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: AZ 37031) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2021-03-19 |