| NPI | 1912933003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: OH 35.067491) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: KY 46877) |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2016-05-23 |