| NPI | 1972796258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MT 2217) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ND 1457) |
| Enumeration Date | 2007-08-21 |
| Last Update Date | 2024-04-19 |