| NPI | 1720280365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME103234) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: OH 57009381) |
| Enumeration Date | 2007-06-05 |
| Last Update Date | 2015-10-13 |