| NPI | 1518954445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: OH 34C.002998) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301071065) |
| Enumeration Date | 2005-10-05 |
| Last Update Date | 2025-09-26 |