| NPI | 1396233748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2018023464) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 62811) |
| Enumeration Date | 2018-05-01 |
| Last Update Date | 2018-07-02 |