| NPI | 1134171994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 14581) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: LA 04724) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2024-08-14 |