| NPI | 1184616401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: OR 162055) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WA MD00036488) |
| Enumeration Date | 2005-08-22 |
| Last Update Date | 2013-05-03 |