| NPI | 1932591716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P18982) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305209301) |
| Enumeration Date | 2015-03-03 |
| Last Update Date | 2019-07-30 |