| NPI | 1992933881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WA MD60342193) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 6115) |
| Enumeration Date | 2009-06-30 |
| Last Update Date | 2013-08-13 |