| NPI | 1033708524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ND 2702) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SD 2250) |
| Enumeration Date | 2021-01-11 |
| Last Update Date | 2023-12-15 |