| NPI | 1538772561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: LA 08113) |
| Additional Taxonomies | 2251N0400X Physical Therapist, Neurology (Licence: LA 08113) |
| Enumeration Date | 2020-08-28 |
| Last Update Date | 2020-08-28 |