| NPI | 1871537563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WA MD00021605) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MO R4N13) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2019-08-27 |