| NPI | 1770039943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P18747) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AR PT 4205) |
| Enumeration Date | 2016-08-28 |
| Last Update Date | 2022-05-25 |