| NPI | 1467970509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NE 3791) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 082965) |
| Enumeration Date | 2017-09-08 |
| Last Update Date | 2019-08-05 |