| NPI | 1578812798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: AR PT3499) |
| 208100000X Physical Medicine & Rehabilitation (Licence: AR 263041497) | |
| Enumeration Date | 2012-09-04 |
| Last Update Date | 2025-06-27 |