| NPI | 1215920772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NE 2426) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ND 1047) |
| Enumeration Date | 2005-08-30 |
| Last Update Date | 2025-04-02 |