| NPI | 1225161458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 5548) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT017346) |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2019-02-15 |