| NPI | 1750305207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: KY 22626) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: OH 35.045267) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2020-05-27 |