| NPI | 1609255512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X (Licence: AZ 67161) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA A169330) |
| Enumeration Date | 2015-05-26 |
| Last Update Date | 2025-01-14 |