| NPI | 1043475098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: CT 007740) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 24148) |
| Enumeration Date | 2008-07-18 |
| Last Update Date | 2020-02-06 |