| NPI | 1700838323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IA 03532) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NV 1721) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2019-02-18 |