| NPI | 1871981936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT025783) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: PA TEI004109) |
| Enumeration Date | 2014-12-24 |
| Last Update Date | 2017-02-07 |