| NPI | 1942521703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2010021886) |
| Enumeration Date | 2010-06-16 |
| Last Update Date | 2024-12-27 |