| NPI | 1316424112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NH 4673) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 3122787) |
| Enumeration Date | 2018-07-24 |
| Last Update Date | 2020-08-04 |