| NPI | 1104924877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 3193) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WY PT768) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2021-02-16 |