| NPI | 1700115482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: LA 331515) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 8558) |
| 225100000X Physical Therapist (Licence: AL 5708) | |
| 208D00000X General Practice (Licence: LA 331515) | |
| Enumeration Date | 2009-12-09 |
| Last Update Date | 2023-11-10 |