| NPI | 1518386614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P0010X Physical Medicine & Rehabilitation, Pediatric Rehabilitation Medicine (Licence: WA MD61415566) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 2020012705) |
| Enumeration Date | 2014-04-16 |
| Last Update Date | 2023-06-08 |