| NPI | 1790752657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH7761) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MS PT4177) |
| Enumeration Date | 2006-03-01 |
| Last Update Date | 2022-05-04 |