| NPI | 1114263340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WA 61293903) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 303164) |
| 225200000X Physical Therapy Assistant (Licence: SC 2860) | |
| Enumeration Date | 2012-12-15 |
| Last Update Date | 2024-02-08 |