| NPI | 1699344549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX 1347018) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA CP031841T) |
| Enumeration Date | 2021-06-23 |
| Last Update Date | 2024-06-03 |