| NPI | 1912921909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AR PT4906) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 4031) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2024-11-18 |