| NPI | 1548445307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA A113590) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: GA 62730) |
| Enumeration Date | 2007-12-29 |
| Last Update Date | 2015-08-19 |