| NPI | 1427378272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD452416) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: OH 35.129461) |
| Enumeration Date | 2010-06-03 |
| Last Update Date | 2016-12-29 |