| NPI | 1356454003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: WA 60072206) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WA MD60072206) |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2021-04-02 |