| NPI | 1033377494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NE 2642) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 004235) |
| Enumeration Date | 2008-06-01 |
| Last Update Date | 2021-03-24 |