| NPI | 1871947911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: OH PT016134) |
| Additional Taxonomies | 171W00000X Contractor (Licence: OH PT016134) |
| Enumeration Date | 2016-04-14 |
| Last Update Date | 2022-03-28 |