| NPI | 1043266737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 7483) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 20292) |
| 225100000X Physical Therapist (Licence: PA PT013966L) | |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2021-11-23 |