| NPI | 1225236672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MA 233494) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA A100528) |
| Enumeration Date | 2007-07-06 |
| Last Update Date | 2016-06-17 |