| NPI | 1750563128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA A 101952) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: CA A-101952) |
| 2081S0010X Physical Medicine & Rehabilitation Sports Medicine (Licence: CA A-101952) | |
| Enumeration Date | 2007-11-28 |
| Last Update Date | 2020-10-23 |