| NPI | 1871727966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA C158024) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: AZ 47238) |
| Enumeration Date | 2009-05-05 |
| Last Update Date | 2022-10-20 |