| NPI | 1750360863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P17832) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT003596L) |
| Enumeration Date | 2006-01-17 |
| Last Update Date | 2020-10-26 |