| NPI | 1861501116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080H0002X (Licence: CA C142768) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WA MD00047266) |
| 2081P0010X Physical Medicine & Rehabilitation, Pediatric Rehabilitation Medicine (Licence: CA C142768) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2020-07-28 |