| NPI | 1194739797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA A65778) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A65778) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2025-09-26 |