| NPI | 1417416272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA 20A22377) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: KY 05597) |
| Enumeration Date | 2019-03-19 |
| Last Update Date | 2024-09-25 |