| NPI | 1326024274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P7333) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 7333) |
| Enumeration Date | 2005-12-21 |
| Last Update Date | 2022-04-26 |