| NPI | 1790185601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 11678) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY 006525) |
| Enumeration Date | 2014-08-27 |
| Last Update Date | 2018-03-17 |