| NPI | 1699066795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA A158004) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NV 16643) |
| 208100000X Physical Medicine & Rehabilitation (Licence: NY 296210) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: AZ 50924) | |
| Enumeration Date | 2011-04-22 |
| Last Update Date | 2022-03-25 |