| NPI | 1497963938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081H0002X Physical Medicine & Rehabilitation, Hospice and Palliative Medicine (Licence: CA G50815) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA G50815) |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2007-07-25 |