| NPI | 1053163014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2024018564) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DC CP032445T) |
| Enumeration Date | 2024-04-03 |
| Last Update Date | 2024-07-09 |