| NPI | 1881829430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA 20A11506) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA STUDENT) |
| Enumeration Date | 2009-05-27 |
| Last Update Date | 2013-07-01 |