| NPI | 1447508239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL 6604) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 23239) |
| Enumeration Date | 2012-08-27 |
| Last Update Date | 2018-02-27 |