| NPI | 1326486275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH8627) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P15973) |
| 225100000X Physical Therapist (Licence: TN 9619) | |
| Enumeration Date | 2013-06-12 |
| Last Update Date | 2022-07-21 |