| NPI | 1588813711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WA 60573972) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NE 25562) |
| Enumeration Date | 2008-09-11 |
| Last Update Date | 2019-02-22 |