| NPI | 1942361423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NM PT2231) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NM 2231) |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2022-03-21 |