| NPI | 1487991097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ND 1667) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305207596) |
| Enumeration Date | 2013-01-16 |
| Last Update Date | 2019-03-07 |