| NPI | 1194994996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA A90732) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A90732) |
| Enumeration Date | 2008-02-26 |
| Last Update Date | 2010-01-08 |