| NPI | 1821067596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: OH 35-091385) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX M1913) |
| Enumeration Date | 2006-03-15 |
| Last Update Date | 2011-06-23 |