| NPI | 1831637768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 040412) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY 006962) |
| 225100000X Physical Therapist (Licence: OR 61943) | |
| Enumeration Date | 2017-02-11 |
| Last Update Date | 2017-02-11 |