| NPI | 1265830731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P17038) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT29945) |
| 225100000X Physical Therapist (Licence: OR P17038) | |
| Enumeration Date | 2014-12-15 |
| Last Update Date | 2018-07-20 |