| NPI | 1669953543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P18976) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 11895) |
| Enumeration Date | 2018-08-28 |
| Last Update Date | 2019-08-06 |