| NPI | 1619451218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: LA 09911) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY 09911) |
| Enumeration Date | 2018-09-19 |
| Last Update Date | 2018-09-26 |