| NPI | 1629543418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: HI 4609) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NV 3777) |
| 225100000X Physical Therapist (Licence: TX 1305106) | |
| Enumeration Date | 2018-10-08 |
| Last Update Date | 2018-10-08 |