| NPI | 1710109905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081H0002X Physical Medicine & Rehabilitation, Hospice and Palliative Medicine (Licence: OH 35089913) |
| Additional Taxonomies | 2081H0002X Physical Medicine & Rehabilitation, Hospice and Palliative Medicine (Licence: OH AO56037246071615) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2011-09-08 |