| NPI | 1144547696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA A120101) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA Pending...) |
| Enumeration Date | 2010-04-23 |
| Last Update Date | 2016-08-27 |