| NPI | 1225231491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA A105856) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA MT183129) |
| 208100000X Physical Medicine & Rehabilitation (Licence: NM MD2009-0677) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: WA MD 60105559) | |
| Enumeration Date | 2007-06-06 |
| Last Update Date | 2020-03-13 |