| NPI | 1942558093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 10920) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT27454) |
| Enumeration Date | 2012-08-21 |
| Last Update Date | 2021-11-23 |