| NPI | 1558451443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P0010X Physical Medicine & Rehabilitation, Pediatric Rehabilitation Medicine (Licence: WA MD00014958) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WA MD00015224) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2009-02-02 |