NPI | 1508088253 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: MI 5101019390) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 6621) |
208100000X Physical Medicine & Rehabilitation (Licence: MI 5101019390) | |
225100000X Physical Therapist (Licence: IA 04000) | |
Enumeration Date | 2007-05-03 |
Last Update Date | 2025-09-22 |