| NPI | 1811005416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC 11242) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 4801) |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2018-12-13 |