| NPI | 1477956944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 62878) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AR PT3885) |
| Enumeration Date | 2014-09-29 |
| Last Update Date | 2024-12-03 |