NPI | 1053549618 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: WA MD60234865) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WA MD60234865) |
Enumeration Date | 2009-06-22 |
Last Update Date | 2023-02-28 |