| NPI | 1669035150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC 18601) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MS PT6636) |
| Enumeration Date | 2019-04-19 |
| Last Update Date | 2019-07-26 |