| NPI | 1346897139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 297756) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY 007754) |
| Enumeration Date | 2019-08-26 |
| Last Update Date | 2019-11-25 |