| NPI | 1740413954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: OH 34013670) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI 5101018438) |
| Enumeration Date | 2009-09-03 |
| Last Update Date | 2023-11-03 |