| NPI | 1598197378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 8346) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 12225) |
| Enumeration Date | 2013-08-05 |
| Last Update Date | 2017-03-29 |