| NPI | 1528223039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA A114752) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA MT186837) |
| 208100000X Physical Medicine & Rehabilitation (Licence: KY TP807) | |
| Enumeration Date | 2008-07-23 |
| Last Update Date | 2012-12-14 |