| NPI | 1184003527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PA OS020708) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WA OL60643074) |
| Enumeration Date | 2015-05-19 |
| Last Update Date | 2022-09-08 |