| NPI | 1326592833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P16707) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 22532) |
| Enumeration Date | 2016-08-12 |
| Last Update Date | 2021-08-31 |