| NPI | 1083832208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 30032) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT018622) |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2024-12-17 |