| NPI | 1497813315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WA MD00029785) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA 29785) |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2011-06-20 |