| NPI | 1023019544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NE 1668) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SD 1065) |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2011-07-29 |