| NPI | 1487145579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 14156) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WI 1415624) |
| Enumeration Date | 2018-05-23 |
| Last Update Date | 2018-06-20 |