| NPI | 1922401827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 8799) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 21273) |
| Enumeration Date | 2014-10-06 |
| Last Update Date | 2018-06-12 |