| NPI | 1649360637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC CP035513T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT009415L) |
| 225100000X Physical Therapist (Licence: NC P23349) | |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2024-10-18 |