| 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 |