| NPI | 1962867226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 9641907-2401) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AK 143474) |
| Enumeration Date | 2015-12-30 |
| Last Update Date | 2021-03-01 |