NPI | 1063916484 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA 20A17899) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA OP61176060) |
208000000X Pediatrics (Licence: WA OP61176060) | |
208100000X Physical Medicine & Rehabilitation (Licence: WA OP61176060) | |
Enumeration Date | 2018-03-20 |
Last Update Date | 2025-09-02 |