| NPI | 1194131177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NH 3978) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 0012310) |
| Enumeration Date | 2014-07-10 |
| Last Update Date | 2016-02-17 |