| NPI | 1811423841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P17081) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 22973) |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2018-11-27 |