NPI | 1962068551 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: CA A190240) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA A190240) |
Enumeration Date | 2019-05-20 |
Last Update Date | 2024-04-28 |