| NPI | 1083889638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: OR MD86581) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WA MD60387536) |
| Enumeration Date | 2008-04-24 |
| Last Update Date | 2021-06-27 |