| NPI | 1467698746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 6178) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P13461) |
| Enumeration Date | 2008-12-17 |
| Last Update Date | 2024-01-03 |