| NPI | 1437498540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: LA 09303R) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL PTH6557) |
| Enumeration Date | 2013-02-08 |
| Last Update Date | 2022-07-21 |