| NPI | 1639155401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P15320) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT-017665) |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2022-11-15 |