| NPI | 1356607980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WA MD60758075) |
| Additional Taxonomies | 204R00000X Electrodiagnostic Medicine (Licence: WA MD60758075) |
| Enumeration Date | 2012-04-09 |
| Last Update Date | 2022-07-21 |