| NPI | 1285906396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: LA 09411) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 27121) |
| Enumeration Date | 2012-02-04 |
| Last Update Date | 2023-06-14 |