| NPI | 1043515430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P0010X Physical Medicine & Rehabilitation Pediatric Rehabilitation Medicine (Licence: DC MD040040) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA A104580) |
| Enumeration Date | 2011-01-18 |
| Last Update Date | 2013-09-25 |