| NPI | 1174926646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 13693) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 29473) |
| Enumeration Date | 2014-09-29 |
| Last Update Date | 2020-06-03 |