| NPI | 1952462947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA G22310) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA G22310) |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2025-09-11 |