| NPI | 1043764681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NE 4304) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NV 3409) |
| Enumeration Date | 2016-08-11 |
| Last Update Date | 2021-12-02 |