| NPI | 1184055147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 7229) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P19818) |
| Enumeration Date | 2013-12-02 |
| Last Update Date | 2025-02-18 |