| NPI | 1821649922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AK 151063) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NH 4551) |
| Enumeration Date | 2019-09-20 |
| Last Update Date | 2019-09-20 |