| NPI | 1447565981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P15385) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 13050) |
| Enumeration Date | 2010-08-09 |
| Last Update Date | 2024-08-22 |