| NPI | 1417061177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WA MD00031763) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA MD00031763) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2016-12-30 |