| NPI | 1750761979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 61496) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 13018-24) |
| 225100000X Physical Therapist (Licence: ND 1994) | |
| Enumeration Date | 2015-06-03 |
| Last Update Date | 2016-12-13 |