| NPI | 1962974436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH9304) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL 1-0967) |
| Enumeration Date | 2018-12-21 |
| Last Update Date | 2019-03-21 |