| NPI | 1790794485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC 14043) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305004407) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2022-07-21 |