| NPI | 1316209968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA 36024) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA 36034) |
| Enumeration Date | 2012-06-11 |
| Last Update Date | 2022-02-11 |