| NPI | 1871931139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: WA MD60783372) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WA MD60783372) |
| Enumeration Date | 2013-06-10 |
| Last Update Date | 2018-06-26 |