| NPI | 1124507942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P17526) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN PT0000011322) |
| 225100000X Physical Therapist (Licence: NY 042344) | |
| Enumeration Date | 2018-08-13 |
| Last Update Date | 2018-08-13 |