| NPI | 1447473913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ND 1736) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 9766024) |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2018-11-20 |