| NPI | 1508109349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WA MD60739177) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: OR MD189020) |
| Enumeration Date | 2013-03-29 |
| Last Update Date | 2020-01-24 |