| NPI | 1659639912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NV 19125) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA A131060) |
| Enumeration Date | 2012-04-24 |
| Last Update Date | 2019-11-22 |