| NPI | 1376823153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA 20a14852) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MD H79855) |
| Enumeration Date | 2011-08-24 |
| Last Update Date | 2024-06-27 |