| NPI | 1730267220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: WA 61016694) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WA 61016694) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2025-08-28 |