| NPI | 1952712275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SD 1970) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 10361) |
| Enumeration Date | 2014-05-09 |
| Last Update Date | 2022-07-21 |