| NPI | 1881242832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IA 092379) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 11-06323) |
| 225100000X Physical Therapist (Licence: AZ LPT-30373) | |
| Enumeration Date | 2019-09-03 |
| Last Update Date | 2020-10-01 |