| NPI | 1285944124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P12895) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY 006228) |
| Enumeration Date | 2010-10-13 |
| Last Update Date | 2023-10-11 |