| NPI | 1972969988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 13065) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 11987) |
| 225100000X Physical Therapist (Licence: MN 10133) | |
| Enumeration Date | 2016-01-06 |
| Last Update Date | 2016-05-08 |