| NPI | 1639568157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IA 004554) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 10008) |
| Enumeration Date | 2015-01-21 |
| Last Update Date | 2015-08-16 |