| NPI | 1992729933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA A66089) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA A66089) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2011-10-06 |