| NPI | 1619234523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA 20A15756) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WA OP60647797) |
| Enumeration Date | 2012-04-16 |
| Last Update Date | 2025-08-11 |