| NPI | 1073619532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: MD 20227) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 20227) |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2023-12-01 |