| NPI | 1700048642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CO 64241) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA A117098) |
| 208100000X Physical Medicine & Rehabilitation (Licence: NY 251971-1) | |
| Enumeration Date | 2008-07-01 |
| Last Update Date | 2022-03-21 |