| NPI | 1164795068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA 20A14038) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL UO2698) |
| Enumeration Date | 2012-02-23 |
| Last Update Date | 2020-04-27 |