| NPI | 1649724196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 3650) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NH CP000117T) |
| 225100000X Physical Therapist (Licence: TX 1278612) | |
| Enumeration Date | 2016-08-12 |
| Last Update Date | 2019-02-05 |