| NPI | 1811017759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WA MD00045379) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD00045379) |
| Enumeration Date | 2007-03-31 |
| Last Update Date | 2011-09-28 |