| NPI | 1619961984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: OH 3537270) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: KY 20708) |
| 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301064876) | |
| Enumeration Date | 2005-09-01 |
| Last Update Date | 2008-05-15 |