| NPI | 1285676924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: AR PT3213) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NE 2450) |
| Enumeration Date | 2006-06-10 |
| Last Update Date | 2010-10-29 |