| NPI | 1285670992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WA OP1945) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: OR DO24951) |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2025-09-08 |