| NPI | 1376801373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA 018544) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 23785) |
| Enumeration Date | 2012-04-26 |
| Last Update Date | 2023-08-09 |