| NPI | 1588088272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P20302) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 9885) |
| 225100000X Physical Therapist (Licence: OR 60495) | |
| Enumeration Date | 2014-02-14 |
| Last Update Date | 2021-06-21 |