| NPI | 1366835605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P14883) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P15433) |
| Enumeration Date | 2015-03-11 |
| Last Update Date | 2021-07-01 |