| NPI | 1760402184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 008299) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT015609L) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2019-01-18 |