| NPI | 1134184203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA 20A12184) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WI 48784) |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2012-03-12 |