| NPI | 1700268000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC 15483) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305209277) |
| Enumeration Date | 2015-06-23 |
| Last Update Date | 2021-01-04 |