| NPI | 1942588694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 23743) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DC 871622) |
| Enumeration Date | 2011-07-29 |
| Last Update Date | 2024-03-03 |