| NPI | 1306061403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P11076) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 7789) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2023-11-08 |