| NPI | 1487629085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MI 5501006967) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501006967) |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2019-08-20 |