| NPI | 1205003027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA A115082) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: ND PT 11831) |
| Enumeration Date | 2008-05-12 |
| Last Update Date | 2016-03-21 |