| NPI | 1801180492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: LA 08759R) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 13125) |
| Enumeration Date | 2011-06-01 |
| Last Update Date | 2022-07-21 |