| NPI | 1093219495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: WA 61400316) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WA 61400316) |
| Enumeration Date | 2018-03-20 |
| Last Update Date | 2023-10-03 |