| NPI | 1518412808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SD 1944) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2016027716) |
| Enumeration Date | 2016-08-17 |
| Last Update Date | 2016-08-17 |