| NPI | 1932316304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: UT 7897793-1204) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WA OP60347769) |
| 208100000X Physical Medicine & Rehabilitation (Licence: MO 2007019024) | |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2023-06-06 |