| NPI | 1114339843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WA MD.MD.61348477) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: OR MD206498) |
| 208100000X Physical Medicine & Rehabilitation (Licence: TX R6535) | |
| Enumeration Date | 2014-05-29 |
| Last Update Date | 2023-10-31 |