| NPI | 1477858207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P15958) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305206745) |
| Enumeration Date | 2011-01-26 |
| Last Update Date | 2021-11-24 |