| NPI | 1720048184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NE 2400) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 03847) |
| Enumeration Date | 2006-03-27 |
| Last Update Date | 2022-06-02 |