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 |