| NPI | 1780694976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P14949) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070-141111) |
| 225100000X Physical Therapist (Licence: SC 7324) | |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2017-09-12 |