| NPI | 1811972615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SD 1136) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NE 2310) |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2017-10-09 |