| NPI | 1548658628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DC 871514) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 0013034) |
| Enumeration Date | 2014-12-25 |
| Last Update Date | 2014-12-25 |