| NPI | 1053654111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: CA A158198) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MO 2014014145) |
| 208100000X Physical Medicine & Rehabilitation (Licence: CA A158198) | |
| Enumeration Date | 2013-03-27 |
| Last Update Date | 2024-04-27 |