| NPI | 1215481700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2016027631) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AR PT4249) |
| Enumeration Date | 2016-08-12 |
| Last Update Date | 2017-01-18 |