| NPI | 1346655396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA A140441) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: SC 92924) |
| 208100000X Physical Medicine & Rehabilitation (Licence: PA MD488693) | |
| Enumeration Date | 2014-06-29 |
| Last Update Date | 2025-03-05 |