| NPI | 1215303979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P17060) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305209652) |
| Enumeration Date | 2015-08-18 |
| Last Update Date | 2017-05-08 |