| NPI | 1154667590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P14944) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 11897) |
| Enumeration Date | 2012-12-12 |
| Last Update Date | 2017-01-03 |