| NPI | 1871939520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WA MD60572245) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA ML 60370985) |
| 207Q00000X Family Medicine (Licence: WA MD60572245) | |
| Enumeration Date | 2013-05-21 |
| Last Update Date | 2021-05-03 |