| NPI | 1215479860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MA 22505) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 292391) |
| Enumeration Date | 2016-11-14 |
| Last Update Date | 2019-05-21 |