| NPI | 1528582467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC 17335) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P17335) |
| Enumeration Date | 2017-08-02 |
| Last Update Date | 2018-03-26 |