| NPI | 1003215120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P15118) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 7495) |
| Enumeration Date | 2014-08-14 |
| Last Update Date | 2016-05-02 |