| NPI | 1710073523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 3519742401) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ID PT1256) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2025-08-13 |