| NPI | 1013191568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TN 13594) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT-23529) |
| 225100000X Physical Therapist (Licence: FL PT23529) | |
| Enumeration Date | 2007-12-19 |
| Last Update Date | 2021-10-19 |