| NPI | 1467778878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WA MD60954929) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA A 118609) |
| Enumeration Date | 2010-04-09 |
| Last Update Date | 2022-03-25 |