| NPI | 1295001493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA A156323) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0101263437) |
| Enumeration Date | 2012-04-02 |
| Last Update Date | 2019-05-10 |