| NPI | 1588627343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH8403) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT013951L) |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2023-11-22 |