| NPI | 1891880894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 0844) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: 0844) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2021-10-04 |