| NPI | 1952392334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA A68882) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NV 9553) |
| Enumeration Date | 2005-11-03 |
| Last Update Date | 2022-05-31 |