| NPI | 1477916385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: LA 09863R) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 12598PT) |
| 225100000X Physical Therapist (Licence: GA PT012297) | |
| Enumeration Date | 2016-03-30 |
| Last Update Date | 2018-12-20 |