| NPI | 1679876593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA 36640) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA 36640) |
| Enumeration Date | 2010-12-15 |
| Last Update Date | 2011-05-11 |