| NPI | 1710283981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH7530) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 25860) |
| 225100000X Physical Therapist (Licence: MS 5631) | |
| Enumeration Date | 2011-02-04 |
| Last Update Date | 2020-12-22 |