| NPI | 1457664518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P0010X Physical Medicine & Rehabilitation, Pediatric Rehabilitation Medicine (Licence: CA A121138) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA A121138) |
| Enumeration Date | 2010-07-19 |
| Last Update Date | 2022-07-21 |