| NPI | 1427623768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: ME PT5952) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2021-05-20 |
| Last Update Date | 2021-11-24 |