| NPI | 1528008620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WA OP60881566) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: AZ 3786) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2018-09-20 |