| NPI | 1942602974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: LA 12004R) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 9618) |
| Enumeration Date | 2014-09-22 |
| Last Update Date | 2025-08-07 |