| NPI | 1467866400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA 20A18377) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI 5101024523) |
| Enumeration Date | 2014-06-18 |
| Last Update Date | 2020-08-12 |