| NPI | 1083806525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MD D81913) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WA MD 60080618) |
| Enumeration Date | 2007-08-17 |
| Last Update Date | 2024-01-16 |