| NPI | 1336524313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IA 087039) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 25564) |
| Enumeration Date | 2015-07-20 |
| Last Update Date | 2020-01-09 |