| NPI | 1558611350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC 13868) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P13868) |
| Enumeration Date | 2012-09-19 |
| Last Update Date | 2025-01-31 |