| NPI | 1639141435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD460115) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WA 60610303) |
| Enumeration Date | 2006-02-06 |
| Last Update Date | 2018-12-20 |