| NPI | 1477974814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P17222) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 20418) |
| Enumeration Date | 2014-01-03 |
| Last Update Date | 2021-08-24 |