| NPI | 1215346820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 62888) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 10229) |
| Enumeration Date | 2014-08-07 |
| Last Update Date | 2022-11-17 |