| NPI | 1124687496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2019031215) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AR PT4657) |
| Enumeration Date | 2019-06-11 |
| Last Update Date | 2019-08-15 |