| NPI | 1720031198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NH 2667) |
| Additional Taxonomies | 174400000X Specialist (Licence: NH 2667) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2020-02-19 |