| NPI | 1306059936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P0010X Physical Medicine & Rehabilitation, Pediatric Rehabilitation Medicine (Licence: CA A107539) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A107539) |
| 208100000X Physical Medicine & Rehabilitation (Licence: CA A107539) | |
| 208000000X Pediatrics (Licence: PA MD435065) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: PA MD435065) | |
| 2081P0010X Physical Medicine & Rehabilitation, Pediatric Rehabilitation Medicine (Licence: PA MD435065) | |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2013-10-03 |