| NPI | 1487971693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: WA MD60301821) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WA MD 60301821) |
| Enumeration Date | 2010-04-27 |
| Last Update Date | 2016-07-22 |