| NPI | 1659339695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation Sports Medicine (Licence: WA MD00040226) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD00040226) |
| 208100000X Physical Medicine & Rehabilitation (Licence: WA MD00040226) | |
| 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: WA MD00040226) | |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2019-05-31 |