| NPI | 1679923999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: OR MD220297) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WA MD60967887) |
| Enumeration Date | 2016-06-17 |
| Last Update Date | 2025-01-29 |