| NPI | 1801919006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 5569) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 21406) |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2016-03-01 |