| NPI | 1538348628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: LA 08911R) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT23558) |
| Enumeration Date | 2007-10-25 |
| Last Update Date | 2023-07-19 |