| NPI | 1831551878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 0989) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: UT 118197-2401) |
| 225100000X Physical Therapist (Licence: AZ 3927) | |
| Enumeration Date | 2016-03-28 |
| Last Update Date | 2016-06-02 |