| NPI | 1790890697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA A103963) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WA ML20008047) |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2023-03-07 |