| NPI | 1508235011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: HI 4044) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: 4044) |
| Enumeration Date | 2015-09-15 |
| Last Update Date | 2021-06-29 |