| NPI | 1336762103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA 20A23835) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI 5315234361) |
| Enumeration Date | 2020-05-27 |
| Last Update Date | 2025-08-01 |