| NPI | 1376952713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: ID 5310) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NV 3018) |
| Enumeration Date | 2014-08-11 |
| Last Update Date | 2020-04-20 |