| NPI | 1447489109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WA MD61046300) |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: NC 2013-01830) |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: MA 241151) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: VA 0101264413) | |
| 208D00000X General Practice (Licence: VA 0101264413) | |
| Enumeration Date | 2009-07-02 |
| Last Update Date | 2023-01-26 |