| NPI | 1487054235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH7315) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT24785) |
| Enumeration Date | 2014-08-29 |
| Last Update Date | 2016-03-15 |