| NPI | 1528095643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301091218) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: OH 35.087412) |
| 208100000X Physical Medicine & Rehabilitation (Licence: PA MD421021) | |
| 208000000X Pediatrics (Licence: MI 4301091218) | |
| 208000000X Pediatrics (Licence: OH 35.087412) | |
| 208000000X Pediatrics (Licence: PA MD421021) | |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2019-08-02 |