| NPI | 1740752815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 27258) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DC PT872403) |
| Enumeration Date | 2018-12-29 |
| Last Update Date | 2019-03-02 |