| NPI | 1639223985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH7998) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 10815) |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2016-07-18 |