| NPI | 1376933408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IA 074339) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NE 3327) |
| Enumeration Date | 2015-01-27 |
| Last Update Date | 2015-01-27 |