| NPI | 1144515743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MT 17169) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 06545) |
| Enumeration Date | 2011-06-13 |
| Last Update Date | 2019-08-14 |