| NPI | 1871092783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2017039916) |
| Enumeration Date | 2018-02-06 |
| Last Update Date | 2018-02-06 |