| NPI | 1629276308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WA OP60570179) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MO 2006017911) |
| 208100000X Physical Medicine & Rehabilitation (Licence: UT 7651257-1204) | |
| Enumeration Date | 2007-07-05 |
| Last Update Date | 2015-07-28 |