| NPI | 1275050114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IA 004837) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NE 3026) |
| Enumeration Date | 2017-08-22 |
| Last Update Date | 2018-03-17 |