| NPI | 1154578565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA 20A 12926) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MO 2008018701) |
| 208100000X Physical Medicine & Rehabilitation (Licence: UT 8206969-1204) | |
| Enumeration Date | 2008-08-27 |
| Last Update Date | 2015-07-04 |