| NPI | 1881148799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 4232) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT025224) |
| Enumeration Date | 2016-08-09 |
| Last Update Date | 2020-07-08 |