| NPI | 1114440559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P18388) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA TPT021941) |
| Enumeration Date | 2017-07-18 |
| Last Update Date | 2019-06-17 |