| NPI | 1639559289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P15570) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 7799) |
| Enumeration Date | 2015-06-08 |
| Last Update Date | 2016-08-24 |