| NPI | 1205196680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P14297) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 9246) |
| Enumeration Date | 2012-05-21 |
| Last Update Date | 2025-05-08 |