| NPI | 1184996357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MA 264822) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA A118040) |
| Enumeration Date | 2012-02-03 |
| Last Update Date | 2015-11-09 |