| NPI | 1033482468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IA 086073) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2012004491) |
| Enumeration Date | 2012-02-15 |
| Last Update Date | 2017-01-31 |