| NPI | 1750876850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PA PT026715) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT026715) |
| Enumeration Date | 2018-06-30 |
| Last Update Date | 2023-12-28 |