| NPI | 1881081560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WA MD60778599) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WA ML60560262) |
| Enumeration Date | 2015-04-21 |
| Last Update Date | 2019-08-15 |