| NPI | 1124247754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: SC 8412) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2024-03-26 |