| NPI | 1730380494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD MD18316) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT22069) |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2024-03-05 |