| NPI | 1538376637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NH 19018) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301503174) |
| 225100000X Physical Therapist (Licence: MA 16811) | |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2023-08-22 |