NPI | 1386791374 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WA MD00016745) |
Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: WA MD00016745) |
2081S0010X Physical Medicine & Rehabilitation Sports Medicine (Licence: WA MD00016745) | |
2081N0008X Physical Medicine & Rehabilitation Neuromuscular Medicine (Licence: WA MD00016745) | |
Enumeration Date | 2007-01-04 |
Last Update Date | 2014-05-21 |