| NPI | 1205282837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX T2978) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA 20A16179) |
| Enumeration Date | 2016-05-12 |
| Last Update Date | 2022-08-19 |