| NPI | 1942384946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RS0010X Internal Medicine Sports Medicine (Licence: CA A64341) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA A64341) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2021-12-13 |