| NPI | 1205162674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P17533) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT25049) |
| Enumeration Date | 2009-10-20 |
| Last Update Date | 2023-10-23 |