| NPI | 1477717072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WA OP 60353188) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: WA OP 60353188) |
| Enumeration Date | 2008-07-12 |
| Last Update Date | 2021-04-29 |