| NPI | 1952681520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IA 117840) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 8525) |
| 225100000X Physical Therapist (Licence: NC P5648) | |
| Enumeration Date | 2011-08-26 |
| Last Update Date | 2024-04-23 |