| NPI | 1114234440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA 20A11543) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI 5101016276) |
| 208100000X Physical Medicine & Rehabilitation (Licence: NV 2865) | |
| Enumeration Date | 2010-09-08 |
| Last Update Date | 2023-12-29 |