| NPI | 1104317262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA A165869) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ R76953) |
| Enumeration Date | 2018-05-24 |
| Last Update Date | 2024-03-31 |