| NPI | 1144398421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0102203735) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA 20A10358) |
| Enumeration Date | 2006-12-02 |
| Last Update Date | 2021-11-10 |