| NPI | 1952733917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AK PHYP2752) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P14451) |
| Enumeration Date | 2013-08-01 |
| Last Update Date | 2023-11-27 |