| NPI | 1962902130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WA PT60973736) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: OR 61206) |
| Enumeration Date | 2018-02-14 |
| Last Update Date | 2024-05-15 |