| NPI | 1801914981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NC 2015-00533) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0116023402) |
| 225100000X Physical Therapist (Licence: NC 10443) | |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2017-10-26 |