| NPI | 1376858829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081H0002X (Licence: CA A119877) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA A119877) |
| Enumeration Date | 2010-08-09 |
| Last Update Date | 2022-09-14 |