| NPI | 1508179391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 7947) |
| 225100000X Physical Therapist (Licence: PA PT020770) | |
| Enumeration Date | 2010-07-21 |
| Last Update Date | 2023-07-31 |