| NPI | 1104015445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SD 2154) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL PTH7950) |
| 225100000X Physical Therapist (Licence: GA PT011438) | |
| 225100000X Physical Therapist (Licence: ND 1398) | |
| Enumeration Date | 2007-10-23 |
| Last Update Date | 2021-09-19 |