| NPI | 1538321757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: OH 35.099882) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MO 200801782) |
| Enumeration Date | 2008-06-29 |
| Last Update Date | 2024-07-17 |