| NPI | 1487732145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WA MD60025245) |
| Additional Taxonomies | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: WA MD60025245) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2013-12-24 |