| NPI | 1427029370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NE 4178) |
| Additional Taxonomies | 174400000X Specialist (Licence: VA 4621) |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2025-01-29 |