| NPI | 1356822704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT-6982) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NV 3854) |
| Enumeration Date | 2018-08-23 |
| Last Update Date | 2020-04-16 |