| NPI | 1114307477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA 20A17172) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MI 5101022796) |
| Enumeration Date | 2015-06-02 |
| Last Update Date | 2023-07-20 |