| NPI | 1366822603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ND 1952) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SD 1848) |
| Enumeration Date | 2015-06-02 |
| Last Update Date | 2023-04-24 |