| NPI | 1225595358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P20904) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 8863) |
| Enumeration Date | 2019-02-25 |
| Last Update Date | 2022-03-21 |