| NPI | 1427165067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA G88894) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WA MD00021629) |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2021-11-30 |