| NPI | 1386272946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WA MD61553389) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: OR MD220605) |
| Enumeration Date | 2020-03-30 |
| Last Update Date | 2026-07-02 |