| NPI | 1912428962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ND 2138) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 8634) |
| Enumeration Date | 2017-06-29 |
| Last Update Date | 2019-12-09 |