| NPI | 1831617695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 4161) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT32657) |
| Enumeration Date | 2017-08-31 |
| Last Update Date | 2020-06-30 |