| NPI | 1740285907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA G87601) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: OH 35076716P) |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2021-12-15 |