| NPI | 1629456058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT-6007) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 61035) |
| Enumeration Date | 2015-05-18 |
| Last Update Date | 2018-12-19 |