| NPI | 1205205853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NM 4714) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 14275) |
| Enumeration Date | 2015-09-24 |
| Last Update Date | 2023-10-20 |