| NPI | 1558987099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P0010X Physical Medicine & Rehabilitation, Pediatric Rehabilitation Medicine (Licence: OH 58.034108) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MO 2020018212) |
| Enumeration Date | 2020-06-21 |
| Last Update Date | 2024-12-28 |