| NPI | 1184057838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 7594) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 24611) |
| Enumeration Date | 2013-08-16 |
| Last Update Date | 2018-01-02 |