| NPI | 1740609742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IA 081272) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NE 3222) |
| Enumeration Date | 2014-04-08 |
| Last Update Date | 2019-02-19 |