| NPI | 1669992418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: CA 20A25378) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NC 2022-01128) |
| 208100000X Physical Medicine & Rehabilitation (Licence: CA 20A25378) | |
| Enumeration Date | 2017-06-22 |
| Last Update Date | 2026-06-27 |