| NPI | 1821336595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH9670) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MS 4556) |
| Enumeration Date | 2013-01-30 |
| Last Update Date | 2019-11-22 |