| NPI | 1043207525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AR PT2457) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: LA 04847R) |
| Enumeration Date | 2005-09-30 |
| Last Update Date | 2023-09-19 |