| NPI | 1407269160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MS PT5387) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P14764) |
| Enumeration Date | 2014-06-10 |
| Last Update Date | 2021-06-16 |