| NPI | 1992110977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WY 12051A) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WA ML60565984) |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: WY 12051A) | |
| Enumeration Date | 2014-06-27 |
| Last Update Date | 2019-06-07 |