| NPI | 1508966615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME76859) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: FL ME 76859) |
| 225100000X Physical Therapist (Licence: FL PT4493) | |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2008-10-02 |