| NPI | 1457665523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 6692) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA 10012) |
| Enumeration Date | 2010-08-01 |
| Last Update Date | 2024-09-26 |