| NPI | 1417218926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P0010X Physical Medicine & Rehabilitation, Pediatric Rehabilitation Medicine (Licence: CA C192708) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35.129684) |
| 208000000X Pediatrics (Licence: CA C192708) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: CA C192708) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: OH 35.129684) | |
| 2081P0010X Physical Medicine & Rehabilitation, Pediatric Rehabilitation Medicine (Licence: OH 35.129684) | |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: CA C191723) | |
| Enumeration Date | 2012-05-31 |
| Last Update Date | 2024-04-29 |