| NPI | 1023713005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 29239) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 29329) |
| Enumeration Date | 2023-03-31 |
| Last Update Date | 2023-04-04 |