| NPI | 1871859942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WA MD60488992) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: WA MD90488995) |
| Enumeration Date | 2012-04-03 |
| Last Update Date | 2022-12-28 |