| NPI | 1487133070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MO 2025025315) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2018028592) |
| Enumeration Date | 2018-08-14 |
| Last Update Date | 2025-07-17 |