| NPI | 1821386335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P15283) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA 010036) |
| 225100000X Physical Therapist (Licence: SC 6515) | |
| Enumeration Date | 2011-07-18 |
| Last Update Date | 2016-08-05 |