| NPI | 1811057664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NE 1004) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 01883) |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2023-10-30 |