| NPI | 1013017060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: WA OP00002223) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: MI 5101018506) |
| 208100000X Physical Medicine & Rehabilitation (Licence: MI 5101018506) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: MN 51136) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: MN 103684) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: WA OL20000101) | |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2021-03-01 |