| NPI | 1114578614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NE 4017) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 098407) |
| Enumeration Date | 2019-09-25 |
| Last Update Date | 2019-11-26 |