| NPI | 1093127441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2014019063) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AR PT 3851) |
| Enumeration Date | 2014-05-20 |
| Last Update Date | 2014-07-29 |