| NPI | 1013091859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 4778) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 19033) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2021-09-11 |