| NPI | 1447228903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA 20A8121) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA 20A8121) |
| Enumeration Date | 2006-03-10 |
| Last Update Date | 2013-10-17 |