| NPI | 1114507993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 345226) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA A201887) |
| Enumeration Date | 2021-04-14 |
| Last Update Date | 2026-08-26 |