| NPI | 1548489040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: OH 35-072150) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TN 58028) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2023-07-12 |