| NPI | 1467948612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 3770) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist (Licence: OH PT016690) | |
| Enumeration Date | 2018-07-10 |
| Last Update Date | 2018-07-11 |