| NPI | 1558843870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 63365) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 11781) |
| Enumeration Date | 2018-09-04 |
| Last Update Date | 2019-08-08 |