| NPI | 1710327804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MT 15229) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WY 1486) |
| Enumeration Date | 2013-07-03 |
| Last Update Date | 2019-01-30 |