| NPI | 1083980254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MN 73410) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WA ML60288621) |
| Enumeration Date | 2012-04-01 |
| Last Update Date | 2023-05-03 |