| NPI | 1285618884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P11928) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT011181) |
| Enumeration Date | 2005-12-06 |
| Last Update Date | 2025-05-01 |