| NPI | 1992126106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 040302) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 60309) |
| Enumeration Date | 2013-12-16 |
| Last Update Date | 2021-04-09 |