| NPI | 1609964261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA G85336) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MN 37882) |
| 208100000X Physical Medicine & Rehabilitation (Licence: WI 71963) | |
| 225400000X Rehabilitation Practitioner (Licence: CA G85336) | |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2024-01-06 |