| NPI | 1881128197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: CA A173493) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MD D98811) |
| Enumeration Date | 2017-04-13 |
| Last Update Date | 2023-12-04 |