| NPI | 1356566020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT5991) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: UT 313219-2401) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2019-04-22 |