| NPI | 1053971838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AR PT4702) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO CP007656T) |
| Enumeration Date | 2019-06-14 |
| Last Update Date | 2021-09-15 |