| NPI | 1447669528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IA 096251) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NE 3390) |
| Enumeration Date | 2014-08-04 |
| Last Update Date | 2024-07-30 |