| NPI | 1033775622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NE 3930) |
| Enumeration Date | 2019-05-20 |
| Last Update Date | 2019-07-22 |