| NPI | 1699037432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX Q7059) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA A131252) |
| Enumeration Date | 2012-06-07 |
| Last Update Date | 2019-05-13 |