| NPI | 1851550404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA A122675) |
| Additional Taxonomies | 208600000X Surgery (Licence: HI MDR-5479) |
| Enumeration Date | 2008-06-08 |
| Last Update Date | 2021-10-01 |