| NPI | 1073743233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA 20A11498) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI 5101018183) |
| Enumeration Date | 2009-07-22 |
| Last Update Date | 2022-08-10 |