| NPI | 1245795152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NE 3905) |
| Enumeration Date | 2019-02-05 |
| Last Update Date | 2019-02-14 |