| NPI | 1245453653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AR PT 2640) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MS PT2502) |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2025-04-14 |