| NPI | 1154860468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC 16900) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT32704) |
| Enumeration Date | 2017-02-20 |
| Last Update Date | 2018-07-24 |