| NPI | 1528807799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NE 4692) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CO PTLP.0000332) |
| Enumeration Date | 2024-05-20 |
| Last Update Date | 2024-08-26 |