| NPI | 1316437940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 0015948) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: ME PT5111) |
| Enumeration Date | 2018-05-18 |
| Last Update Date | 2019-02-11 |