| NPI | 1124063953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NE 1780) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 2839) |
| 225100000X Physical Therapist (Licence: SD 1125) | |
| Enumeration Date | 2006-06-17 |
| Last Update Date | 2022-12-12 |