| NPI | 1700125069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: AZ 10181) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1250878) |
| Enumeration Date | 2013-02-06 |
| Last Update Date | 2024-03-18 |