| NPI | 1639418734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC 16399) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 9663) |
| Enumeration Date | 2013-02-08 |
| Last Update Date | 2016-10-26 |