| NPI | 1770743759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WA OP60302990) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: MD H67675) |
| Enumeration Date | 2008-06-12 |
| Last Update Date | 2019-10-31 |