| NPI | 1699194167 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA A148781) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: NY 302172) |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: CA A148781) | |
| Enumeration Date | 2014-04-14 |
| Last Update Date | 2025-02-07 |