| NPI | 1649679937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC PT7513) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ME PT4962) |
| 225100000X Physical Therapist (Licence: NC P15333) | |
| Enumeration Date | 2014-08-22 |
| Last Update Date | 2018-05-03 |