| NPI | 1396281705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AR PT 1148) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO PT 104934) |
| Enumeration Date | 2017-01-09 |
| Last Update Date | 2017-01-09 |