| NPI | 1851604227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SD 1870) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 6218) |
| Enumeration Date | 2010-07-14 |
| Last Update Date | 2019-11-20 |