| NPI | 1811971815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 4810) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 2706) |
| 2251N0400X Physical Therapist, Neurology (Licence: OR 02706) | |
| 2251N0400X Physical Therapist, Neurology (Licence: NV 4810) | |
| Enumeration Date | 2005-12-02 |
| Last Update Date | 2023-01-03 |