| NPI | 1366718546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA 147920) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WI 61485-20) |
| Enumeration Date | 2012-04-01 |
| Last Update Date | 2021-11-10 |