| NPI | 1871917880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251N0400X Physical Therapist, Neurology (Licence: ID 1570) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ID 1570) |
| Enumeration Date | 2014-02-11 |
| Last Update Date | 2014-02-11 |