| NPI | 1679776157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: OH 35.126656) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME99009) |
| Enumeration Date | 2007-06-11 |
| Last Update Date | 2021-01-14 |