| NPI | 1427478783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX S2506) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA A142342) |
| Enumeration Date | 2014-04-24 |
| Last Update Date | 2026-06-24 |