| NPI | 1669979910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: OH 35.147677) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NC 2022-01093) |
| Enumeration Date | 2018-04-11 |
| Last Update Date | 2023-07-07 |