| NPI | 1396153466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID 6229) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P15158) |
| Enumeration Date | 2014-08-01 |
| Last Update Date | 2025-01-10 |