| NPI | 1821652231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AK 144548) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 63171) |
| 225100000X Physical Therapist (Licence: MA 23218) | |
| Enumeration Date | 2019-05-01 |
| Last Update Date | 2019-06-04 |