| NPI | 1538438163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P18930) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL PT26357) |
| Enumeration Date | 2011-12-28 |
| Last Update Date | 2022-07-19 |