| NPI | 1184805905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WA MD00024397) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: WA MD00024397) |
| 208100000X Physical Medicine & Rehabilitation (Licence: CA G89379) | |
| Enumeration Date | 2007-11-20 |
| Last Update Date | 2025-12-04 |