| NPI | 1538144084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH11634) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P14830) |
| Enumeration Date | 2005-12-07 |
| Last Update Date | 2025-01-27 |