| NPI | 1679881346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA 20A11311) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 253051) |
| Enumeration Date | 2010-09-16 |
| Last Update Date | 2022-07-21 |