| NPI | 1316359391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 3319) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 25000) |
| 225100000X Physical Therapist (Licence: SC 7930) | |
| Enumeration Date | 2014-05-27 |
| Last Update Date | 2016-05-31 |