| NPI | 1942597323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IA 004816) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SD 1811) |
| Enumeration Date | 2011-07-06 |
| Last Update Date | 2022-01-11 |