| NPI | 1821688763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 14982) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WI 14982) |
| Enumeration Date | 2021-01-25 |
| Last Update Date | 2022-01-24 |