| NPI | 1891211546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NE 3746) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 088968) |
| Enumeration Date | 2017-08-15 |
| Last Update Date | 2017-08-28 |