| NPI | 1063426989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WA OP60924421) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA 20A6488) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2019-03-15 |