| NPI | 1992101851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IA 005238) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SD 1719) |
| 225100000X Physical Therapist (Licence: NE 3299) | |
| Enumeration Date | 2014-11-05 |
| Last Update Date | 2014-11-05 |