| NPI | 1871899740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: OR MD183687) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA A112066) |
| Enumeration Date | 2011-02-09 |
| Last Update Date | 2018-05-17 |