| NPI | 1760891923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SD 2085) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 60718) |
| Enumeration Date | 2014-08-12 |
| Last Update Date | 2020-10-09 |