| NPI | 1477705101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA A105399) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD442022) |
| Enumeration Date | 2008-10-13 |
| Last Update Date | 2012-07-06 |