| NPI | 1629269659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WA MD60222712) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WA ML20008988) |
| Enumeration Date | 2007-08-06 |
| Last Update Date | 2011-09-14 |