| NPI | 1407200520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME159088) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: OH 35.139690) |
| Enumeration Date | 2016-04-14 |
| Last Update Date | 2022-12-22 |