| NPI | 1508088253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MI 5101019390) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: MI 5101019390) |
| 225100000X Physical Therapist (Licence: MN 6621) | |
| 225100000X Physical Therapist (Licence: IA 04000) | |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2018-11-27 |