| NPI | 1417481995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA A172694) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA 172694) |
| Enumeration Date | 2017-04-12 |
| Last Update Date | 2022-01-26 |