| NPI | 1124343645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P13659) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 8825) |
| Enumeration Date | 2010-03-29 |
| Last Update Date | 2020-01-23 |