| NPI | 1912198177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 11214) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: CT 000663) |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2020-07-16 |