| NPI | 1033320718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WA MD60672450) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA A94361) |
| 208100000X Physical Medicine & Rehabilitation (Licence: FL ME102414) | |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: FL ME102414) | |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: WA MD60672450) | |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2021-05-19 |