| NPI | 1407385446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P18769) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 087577) |
| Enumeration Date | 2017-06-05 |
| Last Update Date | 2021-03-25 |