| NPI | 1013922608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P13686) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NE PT22782) |
| Enumeration Date | 2006-07-30 |
| Last Update Date | 2021-11-23 |