| NPI | 1124099668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 18673) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 24740) |
| Enumeration Date | 2006-02-01 |
| Last Update Date | 2023-02-09 |