| NPI | 1609103076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P14177) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 8526) |
| Enumeration Date | 2009-11-05 |
| Last Update Date | 2025-10-29 |