| NPI | 1114374741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID 4532) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: UT 7832781-2401) |
| Enumeration Date | 2016-05-24 |
| Last Update Date | 2021-05-21 |