| NPI | 1316180433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 9381) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 8312) |
| Enumeration Date | 2009-04-20 |
| Last Update Date | 2019-01-22 |