| NPI | 1376830596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P0010X Physical Medicine & Rehabilitation, Pediatric Rehabilitation Medicine (Licence: CA 20A14626) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA 20A14626) |
| Enumeration Date | 2011-07-08 |
| Last Update Date | 2023-06-15 |