| NPI | 1003224502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P2611) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 7421) |
| Enumeration Date | 2014-07-28 |
| Last Update Date | 2020-04-03 |