| NPI | 1558532150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation Sports Medicine (Licence: WA MD60289757) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WA MD60289757) |
| Enumeration Date | 2008-03-22 |
| Last Update Date | 2017-03-30 |