| NPI | 1326446477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC 16779) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 29705) |
| Enumeration Date | 2014-12-05 |
| Last Update Date | 2017-01-25 |