| NPI | 1396997029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC 11459) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VT 040.0068954) |
| Enumeration Date | 2008-10-13 |
| Last Update Date | 2023-12-28 |