| NPI | 1912081373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: AZ 45887) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WA MD00031391) |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2019-02-11 |