| NPI | 1154499796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P19608) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 027348) |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2021-09-20 |