| NPI | 1730456690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC CP043040T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NH 3429) |
| Enumeration Date | 2011-11-21 |
| Last Update Date | 2025-03-20 |