| NPI | 1417961020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA C52611) |
| Additional Taxonomies | 204R00000X Electrodiagnostic Medicine (Licence: CA C52611) |
| 208100000X Physical Medicine & Rehabilitation (Licence: OH 35.078782) | |
| 2083X0100X Preventive Medicine, Occupational Medicine (Licence: CA C52611) | |
| 2083X0100X Preventive Medicine, Occupational Medicine (Licence: OH 35.078782) | |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2021-11-29 |