| NPI | 1477084200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 26690) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT025798) |
| Enumeration Date | 2017-03-23 |
| Last Update Date | 2020-10-09 |