| NPI | 1447875745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA PT298262) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI 5501302116) |
| Enumeration Date | 2020-06-11 |
| Last Update Date | 2022-10-04 |