| NPI | 1336201060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC CP01174OT) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 17400) |
| Enumeration Date | 2006-12-16 |
| Last Update Date | 2022-07-14 |