| NPI | 1427489871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 7983) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305208452) |
| Enumeration Date | 2013-12-11 |
| Last Update Date | 2023-04-20 |