| NPI | 1588739494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 7894) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 6870) |
| Enumeration Date | 2006-11-24 |
| Last Update Date | 2021-08-17 |