| NPI | 1306583976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA A208809) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD486516) |
| 208100000X Physical Medicine & Rehabilitation (Licence: PA MT225821) | |
| Enumeration Date | 2022-05-16 |
| Last Update Date | 2026-09-09 |