| NPI | 1861766529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ND 2051) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305206948) |
| Enumeration Date | 2012-02-28 |
| Last Update Date | 2018-07-02 |