| NPI | 1053692954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: VT 040.0077340) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2011-09-06 |
| Last Update Date | 2022-12-31 |