| NPI | 1447495577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 11207) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA PT019632) |
| Enumeration Date | 2008-12-03 |
| Last Update Date | 2024-12-18 |