| NPI | 1861913352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH6140) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT32390) |
| Enumeration Date | 2017-07-05 |
| Last Update Date | 2020-03-09 |