| NPI | 1699898601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WA OP60075152) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MO 2005019083) |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2015-05-04 |