| NPI | 1922199496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: OH 35052282C) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation Sports Medicine (Licence: OH 35052282C) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2020-12-28 |