| NPI | 1952300097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME102427) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: OH 35-063098) |
| Enumeration Date | 2005-07-20 |
| Last Update Date | 2024-04-05 |