| NPI | 1174585343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 1725) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: ID PT-1725) |
| Enumeration Date | 2006-04-04 |
| Last Update Date | 2022-06-24 |