| NPI | 1699064626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P13207) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 13207) |
| Enumeration Date | 2011-03-30 |
| Last Update Date | 2024-12-17 |