| NPI | 1356696660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 62736) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: AZ 9868PT) |
| Enumeration Date | 2012-07-24 |
| Last Update Date | 2018-08-07 |