| NPI | 1497107031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2016024351) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AR PT 4115) |
| Enumeration Date | 2016-07-07 |
| Last Update Date | 2016-07-13 |