| NPI | 1235486820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD PT24169) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 24949) |
| Enumeration Date | 2012-08-14 |
| Last Update Date | 2024-08-15 |