| NPI | 1346671435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA 025955) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DC PT871551) |
| Enumeration Date | 2013-11-27 |
| Last Update Date | 2018-11-14 |