| NPI | 1003382276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT-7250) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: ID PTA-4520) |
| Enumeration Date | 2018-10-16 |
| Last Update Date | 2024-04-22 |