| NPI | 1922208982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081H0002X (Licence: CA A117486) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A117486) |
| 208100000X Physical Medicine & Rehabilitation (Licence: PA mt191678) | |
| Enumeration Date | 2007-07-18 |
| Last Update Date | 2023-03-09 |