| NPI | 1134357650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WA 61364721) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA 61364721) |
| 207Q00000X Family Medicine (Licence: NE 821) | |
| Enumeration Date | 2009-06-23 |
| Last Update Date | 2023-06-02 |