| NPI | 1386970705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX S8300) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WA MD60229186) |
| Enumeration Date | 2009-10-19 |
| Last Update Date | 2022-12-23 |