| NPI | 1639725476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 4252) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 30828) |
| Enumeration Date | 2019-08-16 |
| Last Update Date | 2020-09-15 |