| NPI | 1629202627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD60536623) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WA MD60536623) |
| Enumeration Date | 2009-05-06 |
| Last Update Date | 2020-07-28 |