| NPI | 1346779485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NE 3896) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 62255) |
| Enumeration Date | 2017-06-11 |
| Last Update Date | 2020-11-24 |