| NPI | 1255692687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: OR 6834) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 6834) |
| Enumeration Date | 2012-06-01 |
| Last Update Date | 2022-04-06 |