| NPI | 1477291318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA A206915) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CA A206915) |
| 208100000X Physical Medicine & Rehabilitation (Licence: TX V3701) | |
| Enumeration Date | 2022-05-20 |
| Last Update Date | 2026-08-25 |