| NPI | 1790078178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TN MD54302) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CA A124231) |
| 208100000X Physical Medicine & Rehabilitation (Licence: CA A124231) | |
| Enumeration Date | 2011-05-18 |
| Last Update Date | 2022-03-23 |