| NPI | 1144617499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CO DR.0064796) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WA OP60949092) |
| Enumeration Date | 2015-04-23 |
| Last Update Date | 2021-08-20 |