| NPI | 1588686919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: OH 35121807) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD054600L) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2025-12-02 |