| NPI | 1801291323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P15279) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL.0012670) |
| Enumeration Date | 2014-10-27 |
| Last Update Date | 2015-03-04 |