| NPI | 1750785317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P0010X Physical Medicine & Rehabilitation, Pediatric Rehabilitation Medicine (Licence: WA P160439817) |
| Enumeration Date | 2014-10-10 |
| Last Update Date | 2014-10-10 |