| NPI | 1952695983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: LA 08653R) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 11692-24) |
| Enumeration Date | 2011-06-07 |
| Last Update Date | 2023-09-21 |