| NPI | 1770138760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NM PT5413) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT34203) |
| Enumeration Date | 2019-08-06 |
| Last Update Date | 2019-11-27 |