| NPI | 1336888213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WA DO.OP.70136512) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA R-12583) |
| Enumeration Date | 2022-05-31 |
| Last Update Date | 2026-07-06 |