| NPI | 1255649083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P12823) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 12823) |
| Enumeration Date | 2010-09-14 |
| Last Update Date | 2024-08-22 |