| NPI | 1962430256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 12393) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT16637) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2024-02-12 |