| NPI | 1023533874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WA 61102342) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA 293414) |
| Enumeration Date | 2017-08-12 |
| Last Update Date | 2021-08-31 |