| NPI | 1740815786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P19378) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 10169) |
| Enumeration Date | 2020-03-10 |
| Last Update Date | 2020-04-27 |