| NPI | 1174718902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P9431) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 12913) |
| Enumeration Date | 2007-09-14 |
| Last Update Date | 2022-07-28 |