| NPI | 1578914818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NM 4841) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NV 3733) |
| Enumeration Date | 2016-06-28 |
| Last Update Date | 2019-05-21 |