| NPI | 1558318188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: IA MD-44122) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: OH 35060571) |
| Enumeration Date | 2006-05-28 |
| Last Update Date | 2018-03-17 |