| NPI | 1033383302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NM 3426) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NM 3426) |
| Enumeration Date | 2008-04-17 |
| Last Update Date | 2017-05-09 |