| NPI | 1386639896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 9360) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT015048) |
| Enumeration Date | 2005-09-12 |
| Last Update Date | 2024-12-09 |