| NPI | 1609988989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: KY TP109) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: OH 34-007738) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2014-11-20 |