| NPI | 1356741136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 8479) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: LA 08945R) |
| Enumeration Date | 2014-08-28 |
| Last Update Date | 2024-11-03 |