| NPI | 1083636088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AK 132460) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1119576) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2025-02-12 |