| NPI | 1861478752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX U2417) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: ID M8613) |
| 208100000X Physical Medicine & Rehabilitation (Licence: ID M-8613) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: OH 35.075149) | |
| Enumeration Date | 2005-12-21 |
| Last Update Date | 2025-03-24 |