| NPI | 1720389398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AK 145474) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NH 3137) |
| Enumeration Date | 2010-11-12 |
| Last Update Date | 2020-03-17 |