| NPI | 1174589121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NE 2433) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 03731) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2024-05-20 |