| NPI | 1124404314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC 16633) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC CP027836T) |
| Enumeration Date | 2015-08-11 |
| Last Update Date | 2024-08-22 |