| NPI | 1528357217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA A133798) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: OH 57.020173) |
| Enumeration Date | 2011-04-04 |
| Last Update Date | 2022-02-14 |