| NPI | 1457529562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC 6603) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 6603) |
| Enumeration Date | 2008-02-12 |
| Last Update Date | 2024-10-08 |