| NPI | 1982647350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NC 2006-00628) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WA MD60105638) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2009-12-14 |