NPI | 1528469343 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NC P16792) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: KY 006472) |
225100000X Physical Therapist (Licence: VA 2305208998) | |
Enumeration Date | 2014-09-11 |
Last Update Date | 2022-07-21 |