| NPI | 1508214487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ND 1927) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SD 1918) |
| Enumeration Date | 2016-06-01 |
| Last Update Date | 2019-04-30 |