| NPI | 1992117865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: WA OP61081291) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: UT 10092219-1204) |
| Enumeration Date | 2014-05-27 |
| Last Update Date | 2025-02-13 |