| NPI | 1982115010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NE 3733) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL.0014788) |
| Enumeration Date | 2017-10-16 |
| Last Update Date | 2017-10-16 |