| NPI | 1326433715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WA OP60949854) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WI 6249-851) |
| Enumeration Date | 2015-04-02 |
| Last Update Date | 2019-09-23 |