| NPI | 1265540546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: OR MD09983) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WA MD00023547) |
| Enumeration Date | 2006-08-28 |
| Last Update Date | 2007-07-08 |