| NPI | 1770972960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NE 3162) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: SD 1999) |
| Enumeration Date | 2015-01-12 |
| Last Update Date | 2019-11-25 |