| NPI | 1558424150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ND 834) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ND 0834) |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2022-04-28 |