| NPI | 1881815264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OK 882) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT001253E) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2022-04-04 |