| NPI | 1043502560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WA MD 60386188) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: OR MD177148) |
| Enumeration Date | 2011-05-03 |
| Last Update Date | 2025-10-23 |