| NPI | 1003180241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 61396) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 034812) |
| Enumeration Date | 2012-03-06 |
| Last Update Date | 2018-06-04 |