| NPI | 1144477159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P16967) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 5654) |
| Enumeration Date | 2008-08-20 |
| Last Update Date | 2021-09-24 |