| NPI | 1932507100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID 7071991) |
| Additional Taxonomies | 2251N0400X Physical Therapist, Neurology (Licence: UT 10077818-2401) |
| 225100000X Physical Therapist (Licence: CA 41923) | |
| Enumeration Date | 2014-12-19 |
| Last Update Date | 2025-12-14 |