| NPI | 1225530199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WA PT60706544) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: OR 61835) |
| Enumeration Date | 2018-03-06 |
| Last Update Date | 2018-03-06 |