| NPI | 1942602743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CO 58672) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA A156457) |
| Enumeration Date | 2014-09-23 |
| Last Update Date | 2022-03-30 |