| NPI | 1336641927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID 6011) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 62436) |
| Enumeration Date | 2018-02-28 |
| Last Update Date | 2019-01-12 |