| NPI | 1093167942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NE 3577) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 083433) |
| Enumeration Date | 2016-07-04 |
| Last Update Date | 2016-07-04 |