| NPI | 1184691735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 26980) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NM 3152) |
| Enumeration Date | 2006-03-02 |
| Last Update Date | 2024-07-08 |