| NPI | 1669485553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P10022) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 10022) |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2022-05-18 |