| NPI | 1821202573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WA MD60082337) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MO 2008002494) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2021-04-30 |