| NPI | 1922312727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P15418) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 9825) |
| Enumeration Date | 2010-08-04 |
| Last Update Date | 2023-08-15 |