| NPI | 1003367830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 3473) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 11470) |
| Enumeration Date | 2016-10-17 |
| Last Update Date | 2017-03-10 |