| NPI | 1720142342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: LA 04978) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MS PT4156) |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2021-01-06 |