| NPI | 1609824887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC SC4453) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 4453) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2025-08-15 |