| NPI | 1750750154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IA 078067) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 0013638) |
| Enumeration Date | 2015-09-16 |
| Last Update Date | 2019-12-13 |