| NPI | 1942413547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PR 001188) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PR 1188) |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2022-04-20 |