| NPI | 1104082585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SD 1328) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 004278) |
| Enumeration Date | 2008-08-05 |
| Last Update Date | 2020-10-08 |