| NPI | 1700011350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WA MD60634674) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA Student) |
| Enumeration Date | 2009-05-27 |
| Last Update Date | 2021-05-19 |