| NPI | 1467462127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: ND 1477) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ND 1477) |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2017-10-30 |