| NPI | 1407140940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID 5295) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 9660) |
| 225100000X Physical Therapist | |
| Enumeration Date | 2011-06-01 |
| Last Update Date | 2020-08-31 |