| NPI | 1962443945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA A100046) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: OR MD27724) |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2021-11-05 |