| NPI | 1639194871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: OH 34-00-8814-H) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA OS012397) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2023-11-09 |