| NPI | 1902282403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 3196) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: UT 9046821-2401) |
| Enumeration Date | 2015-08-06 |
| Last Update Date | 2016-09-23 |