| NPI | 1932738309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CO PTL.0013207) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MO 2019019016) |
| 225100000X Physical Therapist (Licence: NJ 40QA02161400) | |
| 225100000X Physical Therapist (Licence: RI PT03646) | |
| 225100000X Physical Therapist (Licence: MI 5501302558) | |
| Enumeration Date | 2020-04-07 |
| Last Update Date | 2023-05-30 |