| NPI | 1689741639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: LA 05146R) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 8823) |
| 225100000X Physical Therapist (Licence: TN 12513) | |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2021-12-07 |