| NPI | 1033194089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: OK 3812) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OK 3812) |
| Enumeration Date | 2005-12-13 |
| Last Update Date | 2024-11-08 |