| NPI | 1265447924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 19706) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 28174) |
| Enumeration Date | 2006-07-30 |
| Last Update Date | 2021-02-05 |