| NPI | 1538516075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SD 1909) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NE 3811) |
| Enumeration Date | 2016-05-14 |
| Last Update Date | 2021-04-15 |