| NPI | 1255674768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WY PT-1887) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: SD 1616) |
| Enumeration Date | 2013-04-03 |
| Last Update Date | 2021-03-03 |