| NPI | 1477796944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WA MD60880401) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: UT 7771206-1205) |
| Enumeration Date | 2009-04-14 |
| Last Update Date | 2025-11-24 |